More than 90% of bleeds occur anteriorly and arise from Little’s area, where the Kiesselbach plexus forms on the septum. [8, 9] The Kiesselbach plexus is where vessels from both the ICA (anterior and posterior ethmoidal arteries) and the ECA (sphenopalatine and branches of the internal maxillary arteries) converge. These capillary or venous bleeds provide a constant ooze, rather than the profuse pumping of blood observed from an arterial origin. Anterior bleeding may also originate anterior to the inferior turbinate.
Posterior bleeds arise further back in the nasal cavity, are usually more profuse, and are often of arterial origin (eg, from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx). A posterior source presents a greater risk of airway compromise, aspiration of blood, and greater difficulty controlling bleeding.
-
Posterior epistaxis from the left sphenopalatine artery.
-
Resolved posterior epistaxis after endoscopic cauterization of the left sphenopalatine artery.
-
Nasal speculum.
-
Vaseline gauze packing.
-
Expandable (Merocel) packing (dry).
-
Nasal vascular anatomy
